Journal of pediatric surgery Article Review: April 2023, IPEG issue
With Dr. Mark Wolkon & Dr. Lucia Toceli & Dr. Farouk Demary & Dr. Chad Thorson · hosted by Dr. Ellen Ancisco & Dr. Todd Ponsky · StayCurrentMD
Cued at 8:54 · stops at 9:39 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Update Course Rewind: Pectus Excavatum 2021
Dr. Todd Ponsky · 11 min · Published Aug 2022
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Cryoablation in 350 Nuss procedures
56 s · Published Oct 2023
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Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
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Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure
1 min · Published Oct 2023
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Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure
51 s · Published Apr 2025
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Update Course Rewind: Pectus Excavatum 2021
11 min · Published Aug 2022
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The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
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What the experts said
The Titanic Index measures the percentage of sternum that lies under the anterior costal line in pectus excavatum patients.
The study included 78 pectus excavatum patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars.
A Titanic Index cutoff of 66.5% predicts need for more than two bars with sensitivity of 93% and specificity of 92%.
The Titanic Index is useful in clinical practice for preoperative planning of pectus excavatum repair.
Time to button battery removal was not a significant predictor of severe outcomes in the Boston series.
The national database study included 577 pediatric choledochal cyst patients aged 0-21 years from 2016 to 2018, with 28% undergoing laparoscopic and 72% open resection.
Most open choledochal cyst procedures were hepaticojejunostomy while most laparoscopic procedures were hepaticoduodenostomy.
Patients receiving open choledochal cyst operations had inferior outcomes including longer length of stay, higher cost, increased TPN use, and more central line requirements.
Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance.
The Titanic Index provides an objective way to determine bar number rather than guessing based on eyeballing or age.
Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, or esophageal stricture development.
The Boston Children's study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes.
Three predictive factors for severe button battery outcomes are: battery in esophagus at presentation, battery size ≥2cm, and presence of any symptoms.
The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed.
There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types.